We estimated the 30-day readmission rate of Medicare
beneficiaries with diabetes, across levels of rurality.
We merged the 2005 Medicare Chronic Conditions 5% sample
data with the 2007 Area Resource File. The study
population was delimited to those with diabetes and at
least 1 hospitalization in the year. Unadjusted
readmission rates were estimated across levels of
rurality. Multivariate logistic regression estimated the
factors associated with readmissions.
Overall, 14.4% had a readmission; this was higher among
urban (14.9%) than rural (12.9%) residents. The adjusted
odds indicated that remote rural residents were less
likely to have a readmission (OR 0.74, 0.57-0.95) than
urban residents. Also, those with a 30-day physician
follow-up visit were more likely to have a readmission
(OR 2.25, 1.96-2.58) than those without a visit.
The factors that contribute to hospital readmissions are
complex; our findings indicate that access to follow-up
care is highly associated with having a readmission. It
is possible that residents of remote rural counties may
not receive necessary readmissions due to lower
availability of such follow-up care. Policy makers should
continue to monitor this apparent disparity to determine
the impact of these lower rates on both patients and