Rural-urban differences in the prevalence, severity, and resource utilization of preventable hospitalizations

The literature suggests that hospitalizations due to ambulatory care sensitive conditions (ACSCs) may be preventable if patients receive timely and adequate primary care. This study examines rural-urban differences in 3 types of ACSC-related hospitalization measures (i.e., hospitalization rate, length of stay, hospital charge). The Agency for Healthcare Research and Quality’s (AHRQ’s) Prevention Quality Indicators were used to identify 13 individual adult-related ACSC indicators and 3 composite indicators (i.e., overall, acute, chronic) based on ICD-9-CM diagnosis and procedure codes. Data were obtained from AHRQ’s 2010 Healthcare Cost and Utilization Project Nationwide Inpatient Sample and the US Census Bureau’s 2010 Intercensal Population Estimates. Rural-urban differences in the rates and proportions were determined using a two-sample z-test to compare the variance of the estimates. Our study suggested that rural residents had a significantly higher preventable hospitalization rate (per 1,000 population) than did their urban counterparts for overall ACSCs (23.3 versus 14.6; p < 0.001), for acute ACSCs (10.2 versus 5.5; p<0.001), and for chronic ACSCs (13.1 versus 9.1; p < 0.001). Rural patients also had a significantly higher proportion of ACSC-related hospital length of stay than did their urban counterparts for overall ACSCs (12.4% versus 10.8%; p = 0.049), and for acute ACSCs (5.3% versus 4.0%; p < 0.001). On the other hand, urban patients had a significantly higher proportion of chronic ACSC-related hospital charges than did their rural counterparts (5.7% versus 4.8%; p = 0.048). These results suggest that rural residents, as compared to their urban counterparts, may be at higher risk of having a preventable hospitalization. Preventable hospitalizations also contribute to a higher percentage of hospital length of stay in rural areas and to a higher percentage of hospital resource utilization in urban areas. Although rural residents may be more vulnerable to having episodes of preventable hospitalization due to their less adequate access to primary care, policy makers should not overlook the problems associated with urban preventable hospitalizations as these hospitalizations consume significant financial resources in urban hospitals. Nevertheless, rural ACSC-related hospitalizations may be easier to prevent as the lower associated resource utilization may be a reflection of lower patient case mix. Using the same data sources, we are currently examining rural-urban differences in the characteristics (demographic and clinical) and determinants of ACSC-related hospitalizations.