Rural-urban differences in preventable hospitalizations among community-dwelling veterans with dementia.
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.
Thorpe
Joshua M
JM
Division of Social and Administrative Sciences, University of Wisconsin School of Pharmacy, Madison, Wisconsin 53705-2222, USA. jthorpe@pharmacy.wisc.edu
Van Houtven
Courtney H
CH
Sleath
Betsy L
BL
Thorpe
Carolyn T
CT
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
J Aging Health. 1993 May;5(2):179-93
10125443
Nurs Res. 2008 Sep-Oct;57(5):312-21
18794715
Aging Ment Health. 2004 Sep;8(5):422-9
15511740
J Health Soc Behav. 1987 Jun;28(2):184-96
3611704
J Gen Intern Med. 2007 Nov;22(11):1487-92
17823840
Health Serv Res. 1983 Spring;18(1):49-74
6841113
Health Aff (Millwood). 1990 Winter;9(4):158-65
2289752
Health Serv Res. 2006 Feb;41(1):79-102
16430602
Gerontologist. 1997 Jun;37(3):355-64
9203759
J Am Board Fam Pract. 2004 Mar-Apr;17(2):150-7
15082675
J Rural Health. 2002 Summer;18(3):467-77
12186321
J Clin Epidemiol. 1996 Dec;49(12):1429-33
8991959
Am J Psychiatry. 1995 Sep;152(9):1349-57
7653692
Am J Occup Ther. 1992 Nov;46(11):1006-12
1463072
Arch Neurol. 2003 Aug;60(8):1119-22
12925369
J Gerontol. 1993 Mar;48(2):S74-83
8473708
JAMA. 2002 Sep 25;288(12):1475-83
12243634
J Health Care Poor Underserved. 2000 Nov;11(4):373-84
11057054
Arch Fam Med. 1999 Nov-Dec;8(6):487-91
10575386
Med Care. 2006 Aug;44(8):713-21
16862032
Can J Rural Med. 2004 Winter;9(1):15-23
15603671
J Rural Health. 2006 Spring;22(2):140-6
16606425
Health Serv Res. 2005 Aug;40(4):953-6
16033486
J Rural Health. 2001 Fall;17(4):356-9
12071561
Am J Community Psychol. 1989 Oct;17(5):625-42
2627025
BMC Med Res Methodol. 2006 Dec 13;6:57
17166270
J Gen Intern Med. 2007 Nov;22(11):1625-7
17882498
Health Serv Res. 2008 Aug;43(4):1164-83
18355256
Arch Intern Med. 2002 Nov 11;162(20):2269-76
12418941
J Rural Health. 2005 Spring;21(2):167-71
15859054
J Am Geriatr Soc. 2004 Feb;52(2):187-94
14728626
Med Care. 1998 Jun;36(6):804-17
9630122
J Rural Health. 1996 Summer;12(3):178-87
10172872
Biol Psychiatry. 2003 Aug 1;54(3):353-62
12893110
Aging Ment Health. 2001 May;5 Suppl 1:S35-48
11513496
Health Serv Res. 2005 Feb;40(1):19-38
15663700