title: The role of rural health clinics in hospitalization due to ambulatory care sensitive conditions: a study in Nebraska.
abstract: BACKGROUND
  Hospitalization due to ambulatory care sensitive conditions (ACSCs) is often used as an indicator for measuring access to primary care. Rural health clinics (RHCs) provide basic primary care services for rural residents in health professional shortage areas (HPSAs). The relationship between RHCs and ACSCs is unclear.
  
  
  OBJECTIVE
  The purpose of this study was to examine the relationship between the presence of RHCs in rural HPSAs and the likelihood of having an acute or chronic ACSC as the reason for hospitalization.
  
  
  METHODS
  Nebraska hospital discharge data (1999-2001) and the 2003 Area Resource File were used in this analysis. A multilevel logistic regression analysis was used to examine the relationship between the presence of RHCs in rural HPSAs and the likelihood of having an ACSC as the reason for hospitalization, after controlling for individual characteristics and county-level contextual factors stratified by 3 age groups. The eligibility for logistic regression was limited to patients from 28 rural Nebraska counties designated as HPSAs in 2001. Patients with commercial payers were excluded from the study.
  
  
  RESULTS
  Elderly patients residing in rural Nebraska HPSAs with at least one RHC were significantly less likely to have a hospitalization due to chronic ACSCs.
  
  
  CONCLUSIONS
  The presence of RHC is a significant factor associated with fewer hospitalizations for chronic ACSCs among the rural elderly residing in HPSAs.
authors.affiliation: Department of Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, Neb. 68198, USA. wazhang@unmc.edu
authors.forename: Wanqing
authors.initials: W
authors.lastname: Zhang
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Mueller
authors.forename: Li-Wu
authors.initials: LW
authors.lastname: Chen
authors.forename: Kevin
authors.initials: K
authors.lastname: Conway
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D016015:Logistic Models; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D009329:Nebraska; D019035:Rural Health Services / Q000706:statistics & numerical data*