title: Rural-urban differences in preventable hospitalizations among community-dwelling veterans with dementia.
abstract: BACKGROUND
  Alzheimer's patients living in rural communities may face significant barriers to effective outpatient medical care.
  
  
  OBJECTIVE
  We sought to examine rural-urban differences in risk for ambulatory care sensitive hospitalizations (ACSH), an indicator of access to outpatient care, in community-dwelling veterans with dementia.
  
  
  METHODS
  Medicare and Veteran Affairs inpatient claims for 1,186 US veterans with dementia were linked to survey data from the 1998 National Longitudinal Caregiver Survey. ACSH were identified in inpatient claims over a 1-year period following collection of independent variables. Urban Influence Codes were used to classify care recipients into 4 categories of increasing county-level rurality: large metropolitan; small metropolitan; micropolitan; and noncore rural counties. We used the Andersen Behavioral Model of Health Services to identify veteran, caregiver, and community factors that may explain urban-rural differences in ACSH.
  
  
  RESULTS
  Thirteen percent of care recipients had at least 1 ACSH. The likelihood of an ACSH was greater for patients in noncore rural counties versus large metropolitan areas (22.6% vs 12.8%, unadjusted odds ratio [OR]= 1.99; P < .01). The addition of other Andersen behavioral model variables did not eliminate the disparity (adjusted OR = 1.97; P < .05).
  
  
  CONCLUSIONS
  We found that dementia patients living in the most rural counties were more likely to have an ACSH; this disparity was not explained by differences in caregiver, care recipient, or community factors. Furthermore, the annual rate of ACSH was higher in community-dwelling dementia patients compared to previous reports on the general older adult population. Dementia patients in rural areas may face particular challenges in receiving timely, effective ambulatory care.
authors.affiliation: Division of Social and Administrative Sciences, University of Wisconsin School of Pharmacy, Madison, Wisconsin 53705-2222, USA. jthorpe@pharmacy.wisc.edu
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Thorpe
authors.forename: Courtney H
authors.initials: CH
authors.lastname: Van Houtven
authors.forename: Betsy L
authors.initials: BL
authors.lastname: Sleath
authors.forename: Carolyn T
authors.initials: CT
authors.lastname: Thorpe
mesh_terms: D000368:Aged; D017028:Caregivers; D003704:Dementia; D006297:Health Services Accessibility; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D008137:Longitudinal Studies; D008297:Male; D012112:Residential Facilities; D012424:Rural Population; D014505:Urban Population; D014728:Veterans
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