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Preventable Hospitalizations: Does Rurality or Non-Physician Clinician Supply Matter?

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Abstract

This study examines the relationship between rurality as well as the proportion of non-physician clinicians and county rates of ambulatory care sensitive hospitalizations (ACSHs) for pediatric, adult and elderly populations in Nebraska. The study design was a cross-sectional observational study of county level factors that affect the county level rates of ACSHs using Poisson regression models. Rural (non-metro) counties have significantly higher ACSHs for both pediatric and adult population, but not for the elderly. Frontier counties have significantly higher adult ACSHs. The proportion of primary care providers who are non-physician clinicians does not have a significant association with ACSHs for any of the age groups. The results indicate that rurality may have a greater impact on pediatric and adult ACSHs and the proportion of NPCs in the primary care provider workforce does not significantly impact ACSH rates.

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References

  1. Millman, M. L. (1993). Access to health care in America. Washington, DC: National Academies Press.

    Google Scholar 

  2. Agency for Healthcare Research and Quality. (2001). AHRQ quality indicators—guide to prevention quality indicators: Hospital admission for ambulatory care sensitive conditions. Rockville, MD: Agency for Healthcare Research and Quality.

    Google Scholar 

  3. Mobley, L., Root, E., Anselin, L., Lozano-Gracia, N., & Koschinsky, J. (2006). Spatial analysis of elderly access to primary care services. International Journal of Health Geographics, 5, 19.

    Google Scholar 

  4. Laditka, J., Laditka, S., & Probst, J. (2005). More may be better: Evidence of a negative relationship between physician supply and hospitalization for ambulatory care sensitive conditions. Health Services Research, 40(4), 1148–1166.

    Article  PubMed  Google Scholar 

  5. Bindman, A., Grumbach, K., Osmond, D., Komaromy, M., Vranizan, K., Lurie, N., et al. (1995). Preventable hospitalizations and access to health care. JAMA: The Journal of the American Medical Association, 274(4), 305–311.

    Article  CAS  Google Scholar 

  6. Ansari, Z., Laditka, J., & Laditka, S. (2006). Access to health care and hospitalization for ambulatory care sensitive conditions. Medical Care Research and Review: MCRR, 63(6), 719–741.

    Article  PubMed  Google Scholar 

  7. Rizza, P., Bianco, A., Pavia, M., & Angelillo, I. (2007). Preventable hospitalization and access to primary health care in an area of Southern Italy. BMC Health Services Research, 7, 134.

  8. Magan, P., Otero, A., Alberquilla, A., & Ribera, J. (2008). Geographic variations in avoidable hospitalizations in the elderly, in a health system with universal coverage. BMC Health Services Research, 8, 42.

    Google Scholar 

  9. Billings, J., Anderson, G., & Newman, L. (1996). Recent findings on preventable hospitalizations. Health Affairs (Project Hope), 15(3), 239–249.

    Article  CAS  Google Scholar 

  10. Brown, A., Goldacre, M., Hicks, N., Rourke, J., McMurtry, R., Brown, J., et al. (2001). Hospitalization for ambulatory care-sensitive conditions: A method for comparative access and quality studies using routinely collected statistics. Canadian Journal of Public Health. Revue Canadienne De Santé Publique, 92(2), 155–159.

    PubMed  CAS  Google Scholar 

  11. Laditka, J. (2004). Physician supply, physician diversity, and outcomes of primary health care for older persons in the United States. Health & Place, 10(3), 231–244.

    Article  Google Scholar 

  12. Cloutier-Fisher, D., Penning, M., Zheng, C., & Druyts, E. (2006). The devil is in the details: Trends in avoidable hospitalization rates by geography in British Columbia, 1990–2000. BMC Health Services Research, 6, 104.

  13. Nedel, F., Facchini, L., Martín-Mateo, M., Vieira, L., & Thumé, E. (2008). Family Health Program and ambulatory care-sensitive conditions in Southern Brazil. Revista De Saúde Pública, 42(6), 1041–1052.

    Article  PubMed  Google Scholar 

  14. Parker, J., & Schoendorf, K. (2000). Variation in hospital discharges for ambulatory care-sensitive conditions among children. Pediatrics, 106(4 Suppl), 942–948.

    PubMed  CAS  Google Scholar 

  15. Gill, J., & Mainous, A. (1998). The role of provider continuity in preventing hospitalizations. Archives of Family Medicine, 7(4), 352–357.

    Article  PubMed  CAS  Google Scholar 

  16. Carter, M., Datti, B., & Winters, J. (2006). ED visits by older adults for ambulatory care-sensitive and supply-sensitive conditions. The American Journal of Emergency Medicine, 24(4), 428–434.

    Article  PubMed  Google Scholar 

  17. Pappas, G., Hadden, W., Kozak, L., & Fisher, G. (1997). Potentially avoidable hospitalizations: Inequalities in rates between US socioeconomic groups. American Journal of Public Health, 87(5), 811–816.

    Article  PubMed  CAS  Google Scholar 

  18. Ansari, Z., Barbetti, T., Carson, N., Auckland, M., & Cicuttini, F. (2003). The Victorian ambulatory care sensitive conditions study: Rural and urban perspectives. Sozial- Und Präventivmedizin, 48(1), 33–43.

    Article  PubMed  Google Scholar 

  19. Begley, C., Slater, C., Engel, M., & Reynolds, T. (1994). Avoidable hospitalizations and socio-economic status in Galveston County, Texas. Journal of Community Health, 19(5), 377–387.

    Article  PubMed  CAS  Google Scholar 

  20. Blustein, J., Hanson, K., & Shea, S. (1998). Preventable hospitalizations and socioeconomic status. Health Affairs (Project Hope), 17(2), 177–189.

    Article  CAS  Google Scholar 

  21. Backus, L., Moron, M., Bacchetti, P., Baker, L., & Bindman, A. (2002). Effect of managed care on preventable hospitalization rates in California. Medical Care, 40(4), 315–324.

    Article  PubMed  Google Scholar 

  22. Gadomski, A., Jenkins, P., & Nichols, M. (1998). Impact of a Medicaid primary care provider and preventive care on pediatric hospitalization. Pediatrics, 101(3), E1.

    Article  PubMed  CAS  Google Scholar 

  23. Saha, S., Solotaroff, R., Oster, A., & Bindman, A. (2007). Are preventable hospitalizations sensitive to changes in access to primary care? The case of the Oregon health plan. Medical Care, 45(8), 712–719.

    Article  PubMed  Google Scholar 

  24. Schreiber, S., & Zielinski, T. (1997). The meaning of ambulatory care sensitive admissions: Urban and rural perspectives. The Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association, 13(4), 276–284.

    Article  CAS  Google Scholar 

  25. Ansari, Z., Carson, N., Serraglio, A., Barbetti, T., & Cicuttini, F. (2002). The Victorian Ambulatory Care Sensitive Conditions study: Reducing demand on hospital services in Victoria. Australian Health Review: A Publication of the Australian Hospital Association, 25(2), 71–77.

    Article  Google Scholar 

  26. Parchman, M., & Culler, S. (1994). Primary care physicians and avoidable hospitalizations. The Journal of Family Practice, 39(2), 123–128.

    PubMed  CAS  Google Scholar 

  27. Krakauer, H., Jacoby, I., Millman, M., & Lukomnik, J. (1996). Physician impact on hospital admission and on mortality rates in the Medicare population. Health Services Research, 31(2), 191–211.

    PubMed  CAS  Google Scholar 

  28. Ricketts, T., Randolph, R., Howard, H., Pathman, D., & Carey, T. (2001). Hospitalization rates as indicators of access to primary care. Health & Place, 7(1), 27–38.

    Article  CAS  Google Scholar 

  29. Culler, S., Parchman, M., & Przybylski, M. (1998). Factors related to potentially preventable hospitalizations among the elderly. Medical Care, 36(6), 804–817.

    Article  PubMed  CAS  Google Scholar 

  30. Silver, M., Babitz, M., & Magill, M. (1997). Ambulatory care sensitive hospitalization rates in the aged Medicare population in Utah, 1990 to 1994: A rural-urban comparison. The Journal of Rural Health, 13(4), 285–294.

    Article  PubMed  CAS  Google Scholar 

  31. Chen, L., Zhang, W., Sun, J., & Mueller, K. (2007). Regional variation in rural hospital charges due to ambulatory care sensitive conditions. Rural Policy Brief, (PB2007-5), 1–4.

  32. Basu, J., & Mobley, L. (2007). Illness severity and propensity to travel along the urban-rural continuum. Health & Place, 13(2), 381–399.

    Article  Google Scholar 

  33. Ricketts, T., Goldsmith, L., Holmes, G., Randolph, R., Lee, R., Taylor, D., et al. (2007). Designating places and populations as medically underserved: A proposal for a new approach. Journal of Health Care for the Poor and Underserved, 18(3), 567–589.

    Article  PubMed  Google Scholar 

  34. Laditka, S., & Johnston, J. (1999). Preventable hospitalization and avoidable maternity outcomes: Implications for access to health services for Medicaid recipients. Journal of Health & Social Policy, 11(2), 41–56.

    Article  CAS  Google Scholar 

  35. Laditka, S., & Laditka, J. (1999). Geographic variation in preventable hospitalization of older women and men: Implications for access to primary health care. Journal of Women & Aging, 11(4), 43–56.

    Article  CAS  Google Scholar 

  36. Laditka, J., & Laditka, S. (2004). Insurance status and access to primary health care: Disparate outcomes for potentially preventable hospitalization. Journal of Health & Social Policy, 19(2), 81–100.

    Article  Google Scholar 

  37. Folland, S. A., Goodman, A. C., & Stano, M. (1997). The economics of health care (2nd ed.). Upper Saddle River, NJ: Prentice Hall.

    Google Scholar 

  38. Derose, K. (2008). Do bonding, bridging and linking social capital affect preventable hospitalizations? Health Services Research, 43(5), 1520–1541. Part I.

    Article  Google Scholar 

  39. Grumbach, K., Seifer, S., Vranizan, K., et al. (1995). Primary care resources and preventable hospitalizations in California. Berkeley, CA: California Policy Seminar.

    Google Scholar 

  40. Basu, J., Friedman, B., & Burstin, H. (2002). Primary care, HMO enrollment and hospitalization for ambulatory care sensitive conditions a new approach. Medical Care, 40(12), 1260–1269.

    Article  PubMed  Google Scholar 

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Correspondence to Preethy Nayar.

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Nayar, P., Nguyen, A.T., Apenteng, B. et al. Preventable Hospitalizations: Does Rurality or Non-Physician Clinician Supply Matter?. J Community Health 37, 487–494 (2012). https://doi.org/10.1007/s10900-011-9468-1

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