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Lower Rehospitalization Rates Among Rural Medicare Beneficiaries With Diabetes

Authors

  • Kevin J. Bennett PhD,

    1. Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, South Carolina
    2. South Carolina Rural Health Research Center, Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina
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  • Janice C. Probst PhD,

    1. South Carolina Rural Health Research Center, Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina
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  • Medha Vyavaharkar MD, PhD,

    1. South Carolina Rural Health Research Center, Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina
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  • Saundra H. Glover PhD

    1. South Carolina Rural Health Research Center, Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina
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  • This report was prepared in part under Grant Award No 6 U1C RH 03711-04-01 with the federal Office of Rural Health Policy, Health Resources and Services Administration. We would like to acknowledge Mr. Robert Chen and Ms. Heather Kirby for their data management assistance for this project. For further information, contact: Kevin J. Bennett, PhD, Assistant Professor, Department of Family and Preventive Medicine, USC School of Medicine, 3209 Colonial Drive, Columbia, SC 29203; e-mail: kevin.bennett@sc.edu.

Abstract

Purpose: We estimated the 30-day readmission rate of Medicare beneficiaries with diabetes, across levels of rurality.

Methods: We merged the 2005 Medicare Chronic Conditions 5% sample data with the 2007 Area Resource File. The study population was delimited to those with diabetes and at least 1 hospitalization in the year. Unadjusted readmission rates were estimated across levels of rurality. Multivariate logistic regression estimated the factors associated with readmissions.

Findings: Overall, 14.4% had a readmission; this was higher among urban (14.9%) than rural (12.9%) residents. The adjusted odds indicated that remote rural residents were less likely to have a readmission (OR 0.74, 0.57-0.95) than urban residents. Also, those with a 30-day physician follow-up visit were more likely to have a readmission (OR 2.25, 1.96-2.58) than those without a visit.

Conclusion: The factors that contribute to hospital readmissions are complex; our findings indicate that access to follow-up care is highly associated with having a readmission. It is possible that residents of remote rural counties may not receive necessary readmissions due to lower availability of such follow-up care. Policy makers should continue to monitor this apparent disparity to determine the impact of these lower rates on both patients and hospitals alike.

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