Chen Hsueh-Fen, Carlson Erin, Popoola Taiye, Suzuki Sumihiro
Department of Health Management and Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas.
Department of Health Policy and Management, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas.
J Rural Health. 2016 Spring;32(2):176-87. doi: 10.1111/jrh.12142. Epub 2015 Sep 8.
To examine the impact of rurality on 30-day preventable readmission, and the illness severity and risk of mortality for 30-day preventable readmissions.
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.
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.
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.
探讨农村地区对30天可预防再入院的影响，以及30天可预防再入院的疾病严重程度和死亡风险。
我们分析了2009年出院后接受家庭健康服务进行急性后护理的医疗保险心力衰竭受益人。该研究采用横断面设计，分析单位为急性后护理的家庭健康事件。数据来源包括：医疗保险受益人汇总文件、医疗保险提供者分析审查、结果评估信息集、家庭健康机构研究可识别文件和地区卫生资源文件。因变量为30天可预防再入院，以及30天可预防再入院的极端/主要疾病严重程度和死亡风险。关键自变量是农村地区，定义为偏远农村、相邻农村和微型都市地区，参考组为城市地区。
偏远农村地区的家庭健康受益人30天可预防再入院率比城市地区低27%。相邻农村地区的家庭健康受益人因可预防情况再入院时疾病严重程度高的可能性比城市地区低33%。
地理位置影响可预防再入院和可预防再入院的疾病严重程度。在对可预防再入院率高的家庭健康机构进行惩罚的财务激励计划的风险调整模型中，应考虑患者的地理位置以及患者的风险因素。
