Lower Rehospitalization Rates Among Rural Medicare Beneficiaries With Diabetes
Lower Rehospitalization Rates Among Rural Medicare Beneficiaries With Diabetes
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DOI：
10.1111/j.1748-0361.2011.00399.x
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发表时间：
2012-06-01
影响因子：
4.9
通讯作者：
Glover, Saundra H.
中科院分区：
文献类型：
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作者：
Bennett, Kevin J.;Probst, Janice C.;Glover, Saundra H.
目的：我们估计了30天的再入院率的医疗保险受益人糖尿病，农村各级。方法：我们将2005年医疗保险慢性病5%样本数据与2007年地区资源文件合并。研究人群被限定为糖尿病患者和年内至少住院1次的患者。未经调整的再入院率估计各级农村。多变量logistic回归估计与再入院相关的因素。结果：总体而言，14.4%的人再次入院;城市居民（14.9%）高于农村居民（12.9%）。调整后的比值表明，偏远农村居民比城市居民更不可能再入院（OR 0.74，0.57-0.95）。此外，那些有30天医生随访的人比那些没有随访的人更有可能再次入院（OR 2.25，1.96-2.58）。结论：导致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。偏远农村县的居民可能由于这种后续护理的可用性较低而无法获得必要的再入院。政策制定者应继续监测这种明显的差异，以确定这些较低的费率对患者和医院的影响。
Purpose: We estimated the 30-day readmission rate of Medicare beneficiaries with diabetes, across levels of rurality. Methods: 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. Findings: 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. Conclusion: 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.