Developing community health resources entices more elderly patients to seek hospital care locally

Research Activities, June 2010, No. 358

Hospitalization for ambulatory-care-sensitive conditions (ACSCs) like hypertension and asthma is typically preventable with proper ambulatory care. In fact, ACSC hospitalization rates in a local area are often viewed as an indicator of access to primary care. Elderly patients with ACSCs are more likely to seek hospital care within their local markets if there is a greater availability of community resources, according to Jayasree Basu, Ph.D., of the Agency for Healthcare Research and Quality (AHRQ) and Lee R. Mobley, Ph.D., of RTI International. Both individual (severity of illness, insurance status) and community factors (availability of primary care and hospital care) can affect whether Medicare patients with ACSCs travel outside their local markets for hospital care.

This study found that more than any other provider or critical access hospital (CAH) variables, local median household income and inpatient hospital capacity affected Medicare patients' decision for a distant hospitalization across the rural-urban continuum. Higher local median household incomes led to more out-of-area travel, while greater local inpatient capacity led patients to seek care at local hospitals.

The researchers used data from 2003 and 2004 hospital discharge files of AHRQ's Healthcare Cost and Utilization Project State Inpatient Databases to examine the role of local community resources on the hospitalization patterns of Medicare patients with ACSCs. They studied Medicare patients in the States of New York, Florida, Pennsylvania, and California, defining local markets as primary care service areas. Results varied somewhat from State to State because of demographic, economic, and policy differences. Only in New York and California were provider supply or CAHs significant factors in affecting travel patterns of Medicare patients. This issue is significant from a policy perspective, because considerable resources are being devoted to the allocation of physicians into underserved areas and providing assistance to small rural hospitals (many of which are CAHs) and health systems, note the researchers.

See "Impact of local resources on hospitalization patterns of Medicare beneficiaries and propensity to travel outside local markets," by Drs. Basu and Mobley, in the Journal of Rural Health 26, pp. 20-29, 2009. Reprints (AHRQ Publication No. 10-R037) are available from the AHRQ Publications Clearinghouse.

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