Get access

Rural-Urban Differences in Preventable Hospitalizations Among Community-Dwelling Veterans With Dementia

Authors

  • Joshua M. Thorpe PhD,

    1. Division of Social and Administrative Sciences, University of Wisconsin School of Pharmacy, Madison, Wisconsin
    Search for more papers by this author
  • Courtney H. Van Houtven PhD,

    1. Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
    2. Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
    Search for more papers by this author
  • Betsy L. Sleath PhD,

    1. Division of Pharmaceutical Policy and Outcomes, University of North Carolina at Chapel Hill School of Pharmacy, Chapel Hill, North Carolina
    Search for more papers by this author
  • Carolyn T. Thorpe PhD

    1. Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
    Search for more papers by this author

  • Joshua Thorpe was supported by an AHRQ National Research Service Award through the Sheps Center for Health Services Research (grant No. T32-HS000032-15), as well as by the American Foundation for Pharmaceutical Education. Courtney Van Houtven was supported by the VA Health Services Research and Development Merit Review Program (MRP 05-311). Additional support for this study is acknowledged through grants from the Health Service Research & Development Program of the Department of Veterans Affairs (NRI-95-218; E. Clipp, PI), NINR (1 P20 NR O7795-01, 1P20NR07795-02; E. Clipp, PI), and a post-doctoral fellowship from the Veterans Affairs Office of Academic Affairs (C. Thorpe). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. For further information, contact: Joshua M. Thorpe, PhD, MPH, Division of Social and Administrative Sciences, University of Wisconsin, Madison School of Pharmacy, 777 Highland Ave. Madison, WI 53705-2222; e-mail jthorpe@pharmacy.wisc.edu.

Abstract

Context: Alzheimer's patients living in rural communities may face significant barriers to effective outpatient medical care.

Purpose: 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.

Findings: 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.

Ancillary