Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
The Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Health Serv Res. 2022 Oct;57(5):1029-1034. doi: 10.1111/1475-6773.14017. Epub 2022 Jul 13.
To determine whether rural Medicare FFS beneficiaries are more likely to be admitted to an urban hospital in 2018 than in 2010.
We combined data from the 2010 to 2018 Hospital Service Area File (HSAF) and the 2010-2017 American Hospital Association (AHA) survey.
We conducted a fixed-effects negative-binomial regression to determine whether urban hospital admissions from rural ZIP codes were increasing over time. We also conducted an exploratory geographically weighted regression.
We transformed the HSAF data into a ZIP code-level file with all rural ZIP codes. We defined rural as having a Rural-Urban Commuting Area (RUCA) code ≥4. A hospital's system affiliation status was incorporated from the AHA survey.
Controlling for distance to the nearest hospitals, an increase of 1 year was associated with a 2.0% increase (p < 0.001) in the number of admissions to urban hospitals from each rural ZIP code. New system affiliation of the nearest rural hospital was associated with an increase of 1.7% (p < 0.001).
Even when controlling for distance to the nearest rural hospital (which reflects hospital closures), rural patients were increasingly likely to be admitted to an urban hospital.
确定 2018 年农村医疗保险 FFS 受益人与 2010 年相比，是否更有可能入住城市医院。
我们结合了 2010 年至 2018 年医院服务区档案（HSAF）和 2010-2017 年美国医院协会（AHA）调查的数据。
我们进行了固定效应负二项回归，以确定农村邮政编码的城市医院入院人数是否随时间增加。我们还进行了探索性的地理加权回归。
我们将 HSAF 数据转换为具有所有农村邮政编码的邮政编码级文件。我们将农村定义为农村-城市通勤区（RUCA）代码≥4。医院的系统隶属关系从 AHA 调查中纳入。
在控制距离最近医院的情况下，每个农村邮政编码的入院人数增加 1 年，与入院人数增加 2.0%（p<0.001）相关。最近农村医院的新系统隶属关系与入院人数增加 1.7%（p<0.001）相关。
即使控制了距离最近的农村医院（这反映了医院关闭），农村患者也越来越有可能被送往城市医院。
