Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, South Carolina 29203, USA.
J Rural Health. 2012 Summer;28(3):227-34. doi: 10.1111/j.1748-0361.2011.00399.x. Epub 2011 Nov 7.
We estimated the 30-day readmission rate of Medicare beneficiaries with diabetes, across levels of rurality.
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.
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.
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.
我们评估了糖尿病医疗保险受益人的 30 天再入院率，按农村程度分级。
我们合并了 2005 年医疗保险慢性病 5%抽样数据和 2007 年地区资源文件。研究人群限定为一年内至少有一次住院且患有糖尿病的患者。在农村程度分级的不同级别上估计未调整的再入院率。多变量逻辑回归估计与再入院相关的因素。
总体而言，有 14.4%的人再入院；城市（14.9%）居民的再入院率高于农村（12.9%）居民。调整后的比值比表明，偏远农村居民的再入院可能性较小（OR 0.74，0.57-0.95），而城市居民的再入院可能性较高。此外，与没有就诊的患者相比，有 30 天医生随访就诊的患者更有可能再入院（OR 2.25，1.96-2.58）。
导致医院再入院的因素很复杂；我们的研究结果表明，获得后续护理与再入院高度相关。由于缺乏这种后续护理，偏远农村县的居民可能无法获得必要的再入院治疗。政策制定者应继续监测这种明显的差异，以确定这些较低比率对患者和医院的影响。
