title: Post-Discharge Adverse Events Among Urban and Rural Patients of an Urban Community Hospital: A Prospective Cohort Study.
abstract: BACKGROUND
  There has been little research to examine post-discharge adverse events (AEs) in rural patients discharged from community hospitals.
  
  
  OBJECTIVE
  We aimed to determine the rate of post-discharge AEs, classify the types of post-discharge AEs, and identify risk factors for post-discharge AEs in urban and rural patients.
  
  
  METHODS
  This was a prospective cohort study of patients at risk for post-discharge adverse events from December 2011 through October 2012.
  
  
  METHODS
  Six hundred and eighty-four patients who were under the care of hospitalist physicians and were being discharged home, spoke English, and could be contacted after discharge, were admitted to the medical service. Patients were stratified as urban/rural using zip code of residence. Rural patients were oversampled to ensure equal enrollment of urban and rural patients.
  
  
  METHODS
  The main outcome of the study was post-discharge AEs based on structured telephone interviews, health record review, and adjudication by two blinded, trained physicians using a previously established methodology.
  
  
  RESULTS
  Over 28% of 684 patients experienced post-discharge AEs, most of which were either preventable or ameliorable. There was no difference in the incidence of post-discharge AEs in urban versus rural patients (ARR 1.04 95% CI 0.82-1.32 ), but post-discharge AEs were associated with hypertension, type 2 diabetes mellitus, and number of secondary discharge diagnoses only in urban patients.
  
  
  CONCLUSIONS
  Post-discharge AEs were common in both urban and rural patients and many were preventable or ameliorable. Potentially different risk factors for AEs in urban versus rural patients suggests the need for further research into the underlying causes. Different interventions may be required in urban versus rural patients to improve patient safety during transitions in care.
authors.affiliation: Department of Family Medicine & Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, 48201, USA, dtsilimi@med.wayne.edu.
authors.forename: Dennis
authors.initials: D
authors.lastname: Tsilimingras
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Schnipper
authors.forename: Ashley
authors.initials: A
authors.lastname: Duke
authors.forename: John
authors.initials: J
authors.lastname: Agens
authors.forename: Stephen
authors.initials: S
authors.lastname: Quintero
authors.forename: Gail
authors.initials: G
authors.lastname: Bellamy
authors.forename: James
authors.initials: J
authors.lastname: Janisse
authors.forename: Laura
authors.initials: L
authors.lastname: Helmkamp
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D000368:Aged; D057286:Electronic Health Records; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010351:Patient Discharge; D011446:Prospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*; D000069341:Transitional Care; D014505:Urban Population / Q000706:statistics & numerical data*
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