The Appalachian Gap in Preventable Hospitalizations: Are We Seeing Any Progress?
The Appalachian Gap in Preventable Hospitalizations: Are We Seeing Any Progress?
复制标题
DOI：
10.13023/jah.0502.02
复制
发表时间：
2023
影响因子：
--
通讯作者：
Waters, Teresa M
中科院分区：
文献类型：
--
作者：
Hogg-Graham, Rachel;Lang, Juan;Waters, Teresa M
以前的研究已经记录了农村和城市地区之间可预防的住院治疗的地理差异，但对异质性农村地区之间可预防的住院治疗模式知之甚少。与获得护理和贫困有关的独特挑战可能使阿巴拉契亚农村地区面临更高的可预防住院率的风险。本研究探讨是否存在肯塔基州的可预防住院率的农村内部差异，以及这些差异如何随着时间的推移而变化。使用2016年至2019年的肯塔基州出院数据，检查了县级可预防住院率的纵向和地理趋势。运行回归模型，以确定可预防住院率随时间的变化是否导致阿巴拉契亚农村县与其城市和农村非阿巴拉契亚同行之间的结果差距增加或减少。农村阿巴拉契亚县始终有显着较高的可预防性住院率相比，农村非阿巴拉契亚和城市同行（p < 0.01）。随着时间的推移，在阿巴拉契亚农村地区观察到整体可预防性住院率呈下降趋势，但在非阿巴拉契亚农村地区和城市县，趋势相对稳定。回归结果表明，随着时间的推移，“阿巴拉契亚差距”没有显着减少。分析证实，肯塔基州的农村地区经历了高度异质性的可预防住院率。尽管医疗补助计划扩大，但几乎没有证据表明“阿巴拉契亚差距”有所缩小。仅仅关注改善获得护理的机会可能不足以改善结果。利用人口健康方法的替代战略可能会提高解决阿巴拉契亚农村地区复杂的健康和社会需求的能力。
Previous studies have documented geographic variation in preventable hospitalizations between rural and urban areas, but much less is known about preventable hospitalization patterns between heterogeneous rural areas. Unique challenges related to access of care and poverty may put the rural Appalachian Region at risk for higher rates of preventable hospitalizations. This study examines whether within-rural differences in Kentucky’s preventable hospitalization rates exist and how these differences may be changing over time. Longitudinal and geographic trends in county-level preventable hospitalization rates were examined using Kentucky hospital discharge data from 2016 to 2019. Regression models were run to determine whether changes over time in preventable hospitalization rates led to an increasing or decreasing gap in outcomes between rural Appalachian counties and their urban and rural non- Appalachian counterparts. Rural Appalachian counties consistently had significantly higher preventable hospitalizations rates compared to their rural non-Appalachian and urban counterparts ( p < 0.01). A downward trend in overall preventable hospitalizations was observed for rural Appalachia over time, but trends were relatively stable for rural non-Appalachian and urban counties. Regression results indicate that there was no significant reduction in the “Appalachian gap” over time. The analyses confirm that rural areas within Kentucky experienced highly heterogeneous rates of preventable hospitalizations. Despite Medicaid expansion, there is little evidence of any narrowing of the “Appalachian gap.” Focus on improving access to care alone may be insufficient to improve outcomes. Alternative strategies that leverage population health approaches may improve capacity to address complex health and social needs in rural Appalachia.