The Impact of Rurality on 30-Day Preventable Readmission, Illness Severity, and Risk of Mortality for Heart Failure Medicare Home Health Beneficiaries.
OBJECTIVE
To examine the impact of rurality on 30-day preventable readmission, and the illness severity and risk of mortality for 30-day preventable readmissions.


METHODS
We analyzed heart failure Medicare beneficiaries who received home health services for postacute care after hospital discharge in 2009. The study was a cross-sectional design with the unit of analysis as the home health episode for postacute care. Data sources included the following: Medicare Beneficiary Summary File, Medicare Provider Analysis Review, Outcome Assessment Information Set, Home Health Agency Research Identifiable File, and Area Health Resources File. The dependent variables were 30-day preventable readmission, and the extreme/major level of illness severity and of risk of mortality for a 30-day preventable readmission. The key independent variable was rurality defined as remote rural, adjacent rural, and micropolitan areas, with urban areas in the reference group.


RESULTS
Home health beneficiaries in remote rural areas had 27% lower 30-day preventable readmission than those in urban areas. Home health beneficiaries in adjacent rural areas were 33% less likely to have high illness severity at readmission due to a preventable condition than those in urban areas.


CONCLUSIONS
Geographical location affects preventable readmission and illness severity of preventable readmission. Patients' geographic location along with patients' risk factors should be taken into consideration in the risk adjustment model for the financial incentive program that penalizes home health agencies with high preventable readmissions.
Department of Health Management and Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas.
Hsueh-Fen
HF
Chen
Department of Health Management and Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas.
Erin
E
Carlson
Department of Health Policy and Management, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas.
Taiye
T
Popoola
Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas.
Sumihiro
S
Suzuki
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality*; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008603:Mental Health; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D012737:Sex Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States
home health; illness severity; preventable readmission; risk of mortality; rural