Diabetes is a condition that requires adequate care to
ensure ideal outcomes. One need is for proper
post-discharge follow-up care to reduce unnecessary
hospital re-admissions. This care is more difficult in
U.S. rural areas due to lower physician and resource
availability. The purpose of this analysis was to examine
U.S. urban-rural differences in 30 day post-discharge
physician follow-up care.
This analysis utilized data from 2005 Medicare claims
files, merged with county-level information from the area
resource file. Beneficiaries with diabetes and with a
hospitalization served as the study population.
Differences in hospitalization rates and 30 day physician
follow-up care were estimated across levels of rurality.
Multi-level multivariate models estimated the factors
that significantly contributed to obtaining such care.
Approximately 90% of the study population had a follow-up
physician visit within 30 days; this rate was lower among
rural beneficiaries. Adjusted estimates indicated that
beneficiaries in rural areas were not less likely to
obtain a follow-up visit. Factors associated with
obtaining a follow up included having addition
comorbidities, being female or White, and living in the
This analysis found evidence that rural Medicare
beneficiaries were less likely to obtain post-discharge
physician follow-up visits within 30 days. The adjusted
result indicate that other factors such as personal
demographic and illness characteristics are more
predictive of this behavior than the rural location
itself. More research is needed to identify why these
specific factors are associated with visit behavior, and
how to design interventions to improve these rates.