In an analysis of data from more than 2 million U.S. elderly adults
hospitalized for stroke, hip fracture, COPD, congestive heart
failure or pneumonia, researchers determined that where you live may
make the difference between life or death, according to the report
in JAMA Network Open.
"Among patients sent for post-acute care, the mortality rate among
urban patients was 4.6% and among rural patients it was 6.6%," said
Cyrus Kosar, a doctoral candidate in the School of Public Health at
Brown University in Providence, Rhode Island. "That's a very, very
large difference. It implies there is some sort of problem with
post-acute care in rural settings."
Kosar and colleagues combed through Medicare data on 2,044,231
patients aged 66 and older who were hospitalized between January
2011 and September 2015.
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Where patients lived did not make a difference in whether they were
sent directly home from the hospital. But among those sent to
post-acute care facilities, patients in rural areas were more likely
than city-dwellers to be sent to a skilled nursing facility rather
than an inpatient rehabilitation facility.
Patients in rural areas were also less likely than urban
counterparts to be discharged to home care.
Rural patients sent home following their hospital stay were somewhat
more likely to die within 30 days of discharge compared to
city-dwellers: 1.8% versus 1.4%.
The much larger rural-urban difference in 30-day mortality among
patients sent for post-acute care is why improving post-acute care
in rural areas could be a way to improve outcomes, Kosar said.
The new study focuses on a "huge problem," said Dr. June McKoy, a
health services researcher at Northwestern University's Feinberg
School of Medicine in Chicago.
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Part of the problem may be that it's very hard to find home
healthcare in rural areas for patients finished with post-acute
care, McKoy said. "Often the distances are far and therapists do not
want to come out to Timbuktu," she explained.
In urban settings, patients receive skilled nursing care in a
post-acute care facility and once they have achieved goals set by
the staff, they transition in most cases to home with home
healthcare, McKoy said. Because home healthcare often isn't
available in rural settings, "rural patients remain in post-acute
care facilities," she added. "Being in a long-term care facility
carries risks. Additionally, older individuals recuperate better at
home post short-stay rehab and have decreased rates of depression
and anxiety."
Dr. Daniel Brotman agreed that some of the difference might come
down to the difficulty in finding home healthcare in rural areas.
Patients tend to do better both psychologically and physically if
they can be cared for at home and can be with loved ones, said
Brotman, director of the hospitalist program at The Johns Hopkins
Hospital in Baltimore.
SOURCE: https://bit.ly/37NRN9m JAMA Network Open, online January 8,
2020.
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