title: Relationships of rurality, home health care use, and outcomes.
abstract: Rural elders have a disproportionate prevalence of illness and limited access to health services. The purpose of this study is to determine whether degree of rurality and home health care use influences home health care patient outcomes. An adaptation of the Outcomes Model for Health Care Research provided the framework for the study. A stratified random sample was selected from a database of risk-adjusted publicly reported patient outcomes from Medicare-certified home health care agencies and merged with agency factors from Medicare cost reports and U.S. Census data. Path analysis was performed to evaluate the relationships in the model. Hospitalization is the only outcome variable associated with community and agency characteristics or home health care use. Rurality does not have a direct effect on hospitalization; however, increased visits per patient and low-income community status are associated with increased hospitalization. Rurality may not have a direct effect on outcomes but instead acts through health care services.
authors.affiliation: University of Wisconsin-Milwaukee, USA. vanderce@uwm.edu
authors.forename: Catherine Prouty
authors.initials: CP
authors.lastname: Vanderboom
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Madigan
mesh_terms: D000368:Aged; D006302:Health Services Research; D006304:Health Status; D006699:Home Care Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016014:Linear Models; D016294:Models, Nursing; D015999:Multivariate Analysis; D015403:Nursing Evaluation Research; D017063:Outcome Assessment, Health Care / Q000458:organization & administration*; D011204:Poverty Areas; D020379:Risk Adjustment; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D014481:United States