Rehospitalization Rates Between Rural and Urban Emergency Departments

Rehospitalization Rates Between Rural and Urban Emergency Departments

Rehospitalization is a common and costly outcome for many patients who are discharged from hospitals. It can indicate poor quality of care, lack of access to appropriate services, or inadequate follow-up. Rehospitalization rates are often used as a measure of health system performance and efficiency. However, rehospitalization rates may vary depending on the setting and location of the hospital and the emergency department (ED) that provides care.

Rural and urban EDs face different challenges and opportunities in reducing rehospitalization rates. Rural EDs may have fewer resources, such as clinical pathways, observation units, or specialty services, to manage complex patients and avoid unnecessary admissions. Rural EDs may also have more difficulty connecting patients to outpatient services, such as primary care, home health, or social support, due to limited availability, transportation barriers, or care coordination issues. On the other hand, rural EDs may have greater access to extended care facilities, such as nursing homes or rehabilitation centers, that can provide alternative care settings for patients who do not require acute hospitalization.

Several studies have examined the trends and factors associated with rehospitalization rates in rural and urban EDs. A cross-sectional study of National Hospital Ambulatory Medical Care Survey data from 2005 to 2016 found that rural ED visit rates increased by more than 50%, from 36.5 to 64.5 per 100 persons, outpacing urban ED visit rates, which increased from 40.2 to 42.8 visits per 100 persons. The study also found that rural EDs had higher proportions of uninsured and Medicaid patients, older patients, and patients with chronic conditions than urban EDs. These factors may contribute to higher rehospitalization risk among rural ED patients.

Another cross-sectional study of a web-based survey of 64 hospital-based EDs in Michigan in 2017 compared rural and urban EDs on resources designed to reduce avoidable admissions. The study found that clinical pathways were equally present in rural and urban EDs (67% vs 74%, p=0.5). However, compared with urban EDs, rural EDs reported greater access to extended care facilities (21% vs 52%, p=0.02) but less access to observation units (52% vs 35%, p=0.04). The study also identified common barriers to connecting ED patients to outpatient services in both settings, such as lack of social support (88% and 76%, p=0.20), patient/family preference (68% and 68%, p=1.0), and time required for care coordination (88% vs 66%, p=0.05).

A retrospective cohort study of Medicare claims data from 2011 to 2013 analyzed the rural-urban differences in nursing home (NH) risk-adjusted rates of any ED visit, outpatient ED visit, and potentially avoidable ED (PAED) visit within six months after NH admission. The study found that over the study period, risk-adjusted rates averaged 9.8% for any ED, 3.3% for outpatient ED, and 3.2% for PAED. Compared with urban NHs, rural NHs were associated with significantly lower rates of any ED, outpatient ED, and PAED (β=−1.67%, −0.44%, and −0.28%; all P <0.01). The study suggested that rural NHs may have lower rehospitalization rates due to lower patient acuity, higher quality of care, or better integration with local health systems. These studies highlight some of the similarities and differences between rural and urban EDs in rehospitalization rates and the factors that influence them. More research is needed to understand the best practices and interventions that can reduce rehospitalization rates in both settings and improve patient outcomes and satisfaction. References: : Trends in Emergency Department Use write my essay by Rural and Urban Populations in the United States | Health Policy | JAMA Network Open | JAMA Network https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2730472 : Are Rural and Urban Emergency Departments Equally Prepared to Reduce Avoidable Hospitalizations? - The Western Journal of Emergency Medicine https://westjem.com/articles/are-rural-and-urban-emergency-departments-equally-prepared-to-reduce-avoidable-hospitalizations.html : Rural-Urban Differences in Nursing Home Risk-adjusted Rates ... - LWW https://journals.lww.com/lww-medicalcare/Abstract/2021/01000/Rural_Urban_Differences_in_Nursing_Home.6.aspx