title: Rural-Urban Differences in the Effect of Follow-Up Care on Postdischarge Outcomes.
abstract: To assess rural-urban differences in quality of postdischarge care among Medicare beneficiaries, controlling for selection bias of postdischarge services.
  
  
  
  The Medicare Current Beneficiary Survey (MCBS), Cost and Use Files from 2000 to 2010, the Area Resource File, Provider of Services File, and the Dartmouth Atlas of Health Care.
  
  
  
  Retrospective analysis of 30- and 60-day hospital readmission, emergency department (ED) use, and mortality using two-stage residual inclusion; receipt of 14-day follow-up care was the main independent variable.
  
  
  
  We defined index admission from the MCBS as any admission without a previous admission within 60 days.
  
  
  
  Noninstrumental variables estimation was the preferred estimation strategy. Fourteen-day follow-up care reduced the risk of readmission, ED use, and mortality. There were no rural- urban differences in the effect of 14-day follow-up care on readmission and mortality. Rural beneficiaries experienced a greater effect of 14-day follow-up care on reducing 30-day ED use compared to urban beneficiaries.
  
  
  
  Follow-up care reduces 30- and 60-day readmission, ED use, and mortality. Rural and urban Medicare beneficiaries experience similar beneficial effects of follow-up care on the outcomes. Policies that improve follow-up care in rural settings may be beneficial.
authors: RTI International, Social Policy, Health and Economics Research, Research Triangle Park, NC.|Health Policy and Management, University of North Carolina, Chapel Hill, NC.
authors: Matthew
authors: M
authors: Toth
authors: Health Policy and Management, University of North Carolina, Chapel Hill, NC.|Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC.
authors: Mark
authors: 0000-0002-6169-7847
authors: M
authors: Holmes
authors: Center for Health Services Research in Primary Care, Durham VA Medical Center, US Department of Veterans Affairs, Durham, NC.|Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC.
authors: Courtney
authors: C
authors: Van Houtven
authors: School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors: Mark
authors: M
authors: Toles
authors: Health Policy and Management, University of North Carolina, Chapel Hill, NC.
authors: Morris
authors: M
authors: Weinberger
authors: Health Policy and Management, University of North Carolina, Chapel Hill, NC.
authors: Pam
authors: P
authors: Silberman
mesh_terms: D000359:Aftercare; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D010351:Patient Discharge; D012189:Retrospective Studies; D012424:Rural Population; D014481:United States; D014505:Urban Population
keywords: ED use; Medicare; follow-up care; postdischarge; readmission; rural