Transitions in Care Among Rural Residents With Congestive Heart Failure, Acute Myocardial Infarction, and Pneumonia


The analysis reported here examines the continuum of care of Medicare beneficiaries as they experience transfers to other facilities, including their post-discharge status (death vs. discharge), post-discharge care (such as nursing home care, skilled nursing care, home healthcare, and primary care follow-up), and potentially preventable readmissions, either to their local hospital or another facility. Inpatient and outpatient claims data were drawn from the Medicare five percent sample files, 2013. To allow comparability across rural and urban patients, the study was restricted to beneficiaries admitted for congestive heart failure (CHF), acute myocardial infarction (AMI), or pneumonia. Patients were followed from their first billed encounter with a hospital, including patients who were seen at an emergency department at the initial hospital and immediately transferred to a second facility.

Rural and Minority Health Research Center
Kevin Bennett, Jarrod Bullard, Yu-Hsiu Lin, Janice Probst